Peculiarities of myocardial remodeling in patients of different age groups 6 months after myocardial infarction

Objective. To assess the nature of changes in the types of myocardial remodeling of the left ventricle in patients of middle, elderly and senile age with acute ST-segment elevation myocardial infarction within 6 months after successful revascularization. Materials and methods. The study included 132 patients with a diagnosis of acute ST-segment elevation myocardial infarction, in combination with arterial hypertension who were divided into 3 groups depending on age: middle-aged patients (45- 59) - 48 people, elderly patients (60-74) - 44 people, senile patients (75-89) - 40 people. The type of left ventricular remodeling was assessed by determining the relative wall thickness and mass index of the left ventricular myocardium with doppler echocardiography in the first 12 hours after the onset of anginal syndrome, and after 6 months. All patients underwent percutaneous coronary intervention. Results. It was found that initially with the development of acute myocardial infarction, senile patients more often had eccentric left ventricular hypertrophy (in 25%) than patients of middle (6%) and elderly age (11%). After 6 months, in middle-aged patients, the type of remodeling eccentric hypertrophy increased to 14%, in the elderly - up to 23%, in senile patients - up to 50%. Conclusion. In patients who have undergone acute myocardial infarction against the background of traditional therapy and rehabilitation, there are changes in the types of left ventricular myocardial remodeling: eccentric hypertrophy increases in middle age up to 14%, in the elderly - up to 23%, in senile age - up to 50%.

1. Babushkina, G.V., Permyakova S.V., Gubayeva A.M. Predictive markers of severity ofpostinfarction in patients of working age who have had Q-myocardial infarction. Medical alphabet. 2020;(21):76-80 (in Russ.). DOI: 10.33667/2078-5631-2020-21-76-80

2. Bukatov V.V. Clinical-anamnestic, laboratory-instrumental, structural and functional peculiarities of older age patients 6 months after myocardial infarction. Challenges in modern medicine. 2021;44(3):332-342 (in Russ.). DOI: 10.52575/2687-0940-2021-44-3-332-342

3. Kalyuzhin V.V., Teplyakov A.T., Solovtsov M.A., Kalyuzhina E.V., Bespalova I.D., Terentyeva N.N. Remodeling of the left ventricle: one or several scenarios? Bulletin of Siberian Medicine. 2016;15(4):120-139. (in Russ.). DOI: 10.20538/1682-0363-2016-4-120-139

4. Kercheva M.A., Ryabova T.R., Gusakova A.M. Adverse left ventricular remodeling and the serum levels of matrix metalloproteinases, biomarkers of myocardium dysfunction and inflammation in patients with acute primary anterior STEMI. The Siberian Medical Journal. 2018;41(1):31-35. (in Russ.)

5. Osipova O.A. Bukatov V.V. Features of myocardial infarction with ST segment elevation in patients of the older age group. Research results in biomedicine. 2020;6(3):402-416 (in Russ.). DOI:10.18413/2658-6533-2020-6-3-0-10

6. Frolov A.A., Kuzmichev K.V., Pochinka I.G., Sharabrin E.G., Savenkov A.G. Effect of late culprit coronary artery revascularization on prognosis of patients with ST-elevation myocardial infarction.Russian journal of cardiology. 2020;25(8):54-59 (in Russ.). DOI: 10.15829/1560-4071-2020-3796

7. Shekhovtsova L.V., Osipova O.A., Golovin A.I., Plaksina K.G., Dolzhikov A.A. Influence of methods of pharmacotherapy in myocardial remodeling of the left ventricle in patients with acute myocardial infarction after reperfusion in the prevention of the formation of CHF. Scientific bulletins of Belgorod State University. Series: Medicine. Pharmacia. 2018;41(4):519-527 (in Russ.). DOI: 10.52575/2687-0940-2021-44-3-332-342

8. Balitskya A., Klester E.B., Klester K.V., Yarkova V., Nikitin V. Heart remodeling in patients after ST-segment elevation myocardial infarction with and without concomitant COPD. Eur Respir J. 2020;56(S64):549. DOI: 10.1183/13993003.congress-2020.549

9. Erne P., Radovanovic D., Schoenenberger A.W., Bertel O., Kaeslin T., Essig M., Gaspoz J.M.; AMIS Plus Investigators. Impact of hypertension on the outcome of patients admitted with acute coronary syndrome. J Hypertens. 2015;33(4):860-867. DOI: 10.1097/HJH.0000000000000343

10. Ertaş F.S., Tokgözoğlu L.; EPICOR Study Group. Pre- and in-hospital antithrombotic management patterns and in-hospital outcomes in patients with acute coronary syndrome: data from the Turkish arm of the EPICOR study. Anatol J Cardiol. 2016;16(12):900-915. DOI: 10.14744/AnatolJCardiol.2016.6755

11. Goldbergova M.P., Parenica J., Jarkovsky J., Kala P., Poloczek M., Manousek J., Kluz K., Kubkova L. et al. The association between levels of tissue inhibitor of metalloproteinase-1 with acute heart failure and left ventricular dysfunction in patients with ST elevation myocardial infarction treated by primary percutaneous coronary intervention. Genet Test Mol Biomarkers. 2012;16(10):1172-1178. DOI: 10.1089/gtmb.2012.0120

12. Kocayigit I., Yaylaci S., Osken A., Aydın E., Sahinkus S., Can Y., Genc A.B., Gunduz H.Comparison of effects of thrombolytic therapy and primary percutaneous coronary intervention in elderly patients with acute ST-segment elevation myocardial infarction on in-hospital, six-month, and one-year mortality. Arch Med Sci Atheroscler Dis. 2019;4:e82-e88. DOI: 10.5114/amsad.2019.85378

13. Lang R.M., Badano L.P., Mor-Avi V., Afilalo J., Armstrong A., Ernande L., Flachskampf F.A., Foster E. et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233-270. DOI: 10.1093/ehjci/jev014

14. Morisky D.E., Green L.W., Levine D.M. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67-74. DOI: 10.1097/00005650-198601000-00007

15. Puzin S.N.,. Grashchenkova A.N., Bogova O.T., Achkasov E.E. Rehabilitation of patients after myocardial infarction at the third stage of recovery. Annals of Anatomy. 2020;230(S):18-19. DOI: 10.1016/j.aanat.2020.151532

16. Rathore S.S., Weinfurt K.P., Foody J.M., Krumholz H.M. Performance of the Thrombolysis in Myocardial Infarction (TIMI) ST-elevation myocardial infarction risk score in a national cohort of elderly patients. Am Heart J. 2005;150(3):402-410. DOI: 10.1016/j.ahj.2005.03.069

17. Sui Y.G., Teng S.Y., Qian J., Wu Y., Dou K.F., Tang Y.D., Qiao S.B., Wu Y.J. Invasive versus conservative strategy in consecutive patients aged 80 years or older with non-ST-segment elevation myocardial infarction: a retrospective study in China. J Geriatr Cardiol. 2019;16(10):741-748. DOI: 10.11909/j.issn.1671-5411.2019.10.006

18. Sutton M.G., Sharpe N. Left ventricular remodeling after myocardial infarction: pathophysiology and therapy. Circulation. 2000;101(25):2981-2988. DOI: 10.1161/01.cir.101.25.2981

19. Tao Y.J., Xia Z.L., Gao Y.J., Gao C.J. Analysis of biomarkers for predicting left ventricular remodeling after successful revascularization of acute myocardial infarction. Journal of Shanghai Jiaotong University (Medical Science). 2019;39(1):60-64. DOI: 10.3969/j.issn.1674-8115.2019.01.011

20. Wojtkowska I., Stępińska J., Stępień-Wojno M., Sobota M., Kopaczewski J., Reszka Z., Kurzelewski M., Medina J. Current patterns of antithrombotic and revascularisation therapy in patients hospitalised for acute coronary syndromes. Data from the Polish subset of the EPICOR study. Kardiol Pol. 2017;75(5): 445-452. DOI: 10.5603/KP.a2017.0034

21. Yoshiyama M., Kamimori K., Shimada Y., Omura T., Kino N., Iida H., Yoshikawa J. Left ventricular remodeling after myocardial infarction in antecedent hypertensive patients. Hypertens Res. 2005;28(4):293-299. DOI: 10.1291/hypres.28.293

22. Yudi M.B., Jones N., Fernando D., Clark D.J., Ramchand J., Jones E., Dakis R., Johnson D. et al. Management of Patients Aged ≥85 Years With ST-Elevation Myocardial Infarction. Am J Cardiol. 2016;118(1):44-48. DOI: 10.1016/j.amjcard.2016.04.010

23. Zhao W, Zhao J, Rong J. Pharmacological Modulation of Cardiac Remodeling after Myocardial Infarction. Oxid Med Cell Longev. 2020;2020:8815349. DOI: 10.1155/2020/8815349